Sequential cleft management with the sliding sulcus technique and alveolar extension palatoplasty.

Conventional methods of cleft lip repair deprive the anterior (buccolingual) alveolar mucoperiosteum of blood supply from the facial-internal maxillary arcade. Six months later, at palatoplasty, lingual incisions permanently isolate the lingual mucoperiosteum from its blood supply--the greater palatine artery. The osteogenic alveolar mucoperiosteum is thus converted from a richly supplied boundary zone between the two angiosomes into an isolated tissue dependent on osseus backflow. Cleft-sided growth disturbance is considered from this perspective. Subperiosteal techniques that preserve the blood supply to this tissue are considered in a sequential plan of cleft management.